It arrives. It requires a signature and its from the insurance company. Any office manager or insurance manager in the industry long enough knows what this means...the dreaded audit. Audits can be an incredibly stressful and scary time for any provider. Time, energy, man hours, paper, mind space on which chart you forgot to sign instead of focusing on the patient in front of you. However, be preemptive in this battle! The question of is not whether or not your office will be audited - it is WHEN will your office be audited. Small or large, everyone eventually hits some sort of audit. This does not mean you are a bad office or that you did anything wrong per se, its all about logistics and algorithms and sometimes your number is called. But, there are things you can do to make this situation easier when it arrives. First, prepare a mock audit. Be hard on your self. Designate an ethical individual in the office and randomly start reviewing charts to see what you find. Be your harshest critic and then implement safe guards against what you find. If you are having trouble getting started or need help with an audit, Triple B will perform an outside mock audit for your office to see where you stand. We are here to help!
United Healthcare to Adopt Fee Per Visit reimbursement
In aligning with the changing times, United Health Care is adopted a "fee per visit" reimbursement" rather than a "fee per service." This means that UHC will reimburse ONE FLAT RATE per day - regardless of the number of services performed. The mentality behind this theory is that eventually it will even out. On day 1, you may perform an exam, x-ray, treatment and receive one lower flat payment but on Day 2-3 where you perform less services, that payment seems higher. All seems fine and dandy - except for those patients that never return past visit 1 or 2...
Update your EFT with Highmark
Did you know that you can easily update your EFT registration through Navinet? If you are unsure, send me an email and I can walk you through it. All participating providers with Highmark must have their EFT enrollment up to date by the end of March 2016 to avoid disruption of payments.
Highmark adopts Medicare Timed Therapy code rules!
Highmark Blue Cross Blue Shield will adopt Medicare’s method on counting minutes for timed therapy codes. Please reference claims processing publication 100-04 from CMS for complete details. When more than one service represented by 15-minute timed codes is performed in a single day, the total number of minutes of service (as noted in the chart below) determines the number of timed units billed. The expectation (based on the work value for these codes) is that the provider’s direct patient contact time for each unit will average 15 minutes in length. If only one service is provided in a day, providers should not bill for the services performed for less than 8 minutes. For any single timed CPT code in the same day measured in 15-minute units, providers bill a single 15-minute unit for treatment greater than or equal to 8 minutes through and including 22 minutes. If the duration of a single modality, or procedure in a day, is greater than or equal to 23 minutes, through and including 37 minutes, then 2 units should be billed. The pattern remains the same for treatment times in excess of the chart below.
Timed intervals for 1 through 8 units are as follows:
8 - 22 minutes 1 unit
23 - 37 minutes 2 units
38 - 52 minutes 3 units
53 - 67 minutes 4 units
68 - 82 minutes 5 units
83 – 97 minutes 6 units
98 – 112 minutes 7 units
113 – 127 minutes 8 units
Example:
18 minutes therapeutic exercise (97110)
13 minutes of manual therapy (97140)
10 minutes of gait training (97116)
8 minutes of ultrasound (97035)
49 Total timed minutes
Appropriate billing is for 3 units. Bill the procedures you spent the most time providing. You would have 1 unit each of 97110, 97116, and 97140. You are unable to bill for the ultrasound because the total time of timed units that can be billed is constrained by the total timed code treatment minutes (i.e., you may not bill 4 units for less than 53 minutes regardless of how many services were performed). You would still document the ultrasound in the notes.
Individuals held liable for Corporate wrongdoings in Yates Memo
In September of 2015, the Yates Memo was signed stating that individuals will now be investigated and held liable for corporate wrong doings. This means that if a corporatation is going down for medical billing or coding fraud, the individuals and the corporate entity will now be investigated. Medical biller and codes beware. Maintain your ethics and compliance standards! No longer will just the large corporate go down, the law states that under certain circumstance (regardless of ability to pay) the individuals involved within the corporation will also be investigated and held liable. When in the past medical billing managers and coders could hide behind the corporation, now they will be in the spot light for fraud and abuse. This is a a positive step in maintaining the ethics and integrity of the medical billing and coding profession.
Read more here: http://www.justice.gov/dag/file/769036/download
Highmark Updates its Authorization Program
Highmark recently updated the authorization process. If you have ever had the unfortunate situation of having to call in an urgent, priority, or difficult authorization, you could expect long hold times and speaking with a not-so-thrilled nurse reviewer, but you could accomplish your task. Now Highmark has instituted a call back system! No more just waiting on hold for endless hours. Callers are now prompted to leave a message and have their call returned. Solution? Plan ahead for your authorizations and avoid the call back. Be pro active and check your schedule a few days in advance to start those lengthy authorization procedures on line without having to call it in at the last minute.